Relaxing suture yields good results in tendon repairs - Academy News at the 2007 AAOS Annual Meeting

Relaxing suture yields good results in tendon repairs

By Mary Ann Porucznik

Using a “relaxing suture” for quadriceps and patellar tendon repairs accelerates rehabilitation and yields good-to-excellent results, according to the study featured in poster exhibit P498. This suture technique reduces tension on the repair and permits limited knee flexion within two weeks of surgery.

Although most surgeons prescribe 4-to-6 weeks of immobilization and 12 weeks of bracing after quadriceps and patellar tendon repairs, such a lengthy period of immobilization can lead to complications. Early motion is recommended to avoid problems such as arthrofibrosis, muscle atrophy, and deep vein thrombosis. In this study, the use of a “relaxing suture” enabled a postoperative regimen of early motion and full weight bearing 10 days after surgery.

(Left) Two Krakow stitches are placed in the tendon and three longitudinal holes are drilled in the patella. (Middle) The tendon is pulled into the trough that was created in the inferior pole by passing the sutures through the holes. (Right) The No. 5 Ethibond "relaxing suture" is then placed with the knee at 30 degrees* of flexion to protect the repair and allow early motion of the knee.

This retrospective, IRB-approved study included 50 consecutive patients—the largest series to date to document results of such an accelerated rehabilitation program. Two surgeons performed 20 quadriceps and 30 patellar tendon repairs.

A No. 5 Ethibond “relaxing suture” was used to reduce tension on the repair from 0 to 55 of knee flexion. When placed with the knee flexed at 30, the relaxing suture allows up to 50 to 55 of flexion due to the inherent slack in the tendon-suture construct.

Ten days after surgery and for the next four-to-five weeks, the postoperative hinged knee brace was removed daily for limited (0 to 55) active motion of the knee. After six weeks, 120 of flexion and brace-free ambulation became the objectives of therapy. These two goals were achieved in both the quadriceps and patellar tendon repair groups at an average of 8.4 weeks. Within six months, all patients—including a police officer, mountain guide, and triathlete—reached their pre-injury level of activity. Of the 50 patients, 41 achieved full extension and the remaining 9 came within 3 to 10 of full extension.

At a minimum follow-up of 12 months, the results were assessed with the Lysholm knee rating scale. Lysholm scores averaged 92 points (range: 81 to 100 points), confirming that the “relaxing suture” and the early “protected” motion it enables avoid the complications of prolonged immobilization and produce good-to-excellent results.

The lead investigator is Jesse West, MD, of Madison, Wis. The principle surgeons are James S. Keene, MD, and Lee D. Kaplan, MD, also of Madison, Wis. The authors report no conflicts of interest.

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